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PROF. IBRAHIM A. AL-MOFLEH Professor of Medicine, College of Medicine

PROF. IBRAHIM A. AL-MOFLEH Professor of Medicine, College of Medicine & University Hospitals, KSU. ACUTE GI – BLEEDING (AGIB). AGIB.

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PROF. IBRAHIM A. AL-MOFLEH Professor of Medicine, College of Medicine

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  1. PROF. IBRAHIM A. AL-MOFLEH Professor of Medicine, College of Medicine & University Hospitals, KSU

  2. ACUTE GI – BLEEDING(AGIB)

  3. AGIB A 60 yrs old patient was brought with the ambulance to the emergency room with acute GI-bleeding ; you are asked to care for this patient ; a- Whatare your plans (objectives) ? b- How would you approach him ? c- Mentionthe adverse prognostic factors ?

  4. AGIB Objectives • Maintain the hemodynamics • Determine the level • Determine the cause • Treat and prevent rebleeding

  5. AGIB • Initial assessment • Resuscitation • History and exam • Lab evaluation • Localization • Treatment 1- How to approach the patient ?

  6. AGIB 1. Initial assessment A - How urgent is the situation ? stable or in shock ? What are the features of shock ? What is the magnitude of blood loss ?

  7. AGIB • B-What are the features of shock ? • Agitation • Pallor • Hypotension • Tachycardia Initial assessment

  8. AGIB VSBlood loss(% of total volume) Severity of bleed Normal < 10% Mild Postural drop 10 – 20% Moderate Shock > 20% Severe C- How to assess the magnitude of blood loss?

  9. AGIB • Initial assessment • Resuscitation • History and exam • Lab evaluation • Localization • Treatment 2. How to approach the patient ?

  10. AGIB 2. Resuscitation Hemodynamically unstable patient • Restore and maintain hemodynamics • Oxygen • Monitor VS and urinary output • Admission to ICU • Blood transfusion • ? FFP

  11. AGIB

  12. AGIB Resuscitation Indications for blood transfusion • Unstable VS • Continuous bleeding • Bright blood • Age > 60 • Concomitant CPD

  13. AGIB • Initial assessment • Resuscitation • History and exam • Lab evaluation • Localization • Treatment 3. How to approach a patient with AGIB?

  14. AGIB History Exam Age Stigmata of CLD Dyspepsia Hereditary vascular anomalies Previous endoscopy Scars Previous PUD Palpable organs / masses Previous bleeding Lymphadenopathy CLD PR Drugs Anorexia Weight loss Changing bowel habits Previous surgery (PUD, aortic graft etc..) 3. History and examination

  15. AGIB • Initial assessment • Resuscitation • History and exam • Lab evaluation • Localization • Treatment 4. How to approach a patient with AGIB?

  16. AGIB • CBC, PT, PTT, • type and crossmatching • BUN , BUN / Creatinin ratio • Liver profile • ABG 4. Laboratory parameters

  17. AGIB • Initial assessment • Resuscitation • History and exam • Lab evaluation • Localization • Treatment 5. How to approach a patient with AGIB?

  18. AGIB 5. Localization • Clinical • Endoscopy • Radiological • RBC scan • Angiography

  19. AGIB • Initial assessment • Resuscitation • History and exam • Lab evaluation • Localization • Treatment 6. How to approach a patient with AGIB?

  20. AGIB 6. Treatment • Pharmacological • Endoscopic • Angiographic • Surgical

  21. AGIB Indications for emergency endoscopy Cirrhosis Persistent bleeding Rebleeding • Cause • Severity • Age

  22. AGIB Role of endoscopy • Site of bleeding • Source of bleeding • Stigmata of bleeding PU • Endoscopic therapy

  23. AGIB • Clinical • Old age • Comorbid diseases • Bright blood (NGA, vomitus, stool) • Onset of bleeding in the hospital • Amount of blood lost • Shock or hypotension on presentation • Emergency surgery C- Adverse prognostic factors

  24. AGIB • Endoscopic • Vascular bleeding • Active bleeding • Visible vessel • Clot • Giant ulcer Adverse prognostic factors

  25. ACUTE GI – BLEEDING

  26. AGIB Forms • Upper • Lower • Obscure

  27. AGIB • Common (e.g. 15000 deaths/yr in USA) • Upper is 5 x more than lower • More frequent in men and elderly • Spontaneous cessation in 80% • Mortality in general 10% • in elderly 20% • cont. bl/rebleeding >30% Epidemiology

  28. Bleeding Esophageal Varices

  29. EVL

  30. GU – Visible Vessel

  31. Sentinel Clot

  32. Gastric Angiodysplasia

  33. Bleeding Angiodysplasia

  34. DU – Bleeding Control

  35. Gastric Varices

  36. Bleeding GU

  37. DU – Bleeding

  38. GU Clips

  39. Bleeding Diverticulum

  40. Diverticulum Visible Vessel

  41. Bleeding hemorrhoids

  42. Dieulafoy - Colon

  43. AGIB • Initial assessment • Resuscitation • History and exam • Lab evaluation • Localization • Treatment Summary 0f patients approach

  44. الحمد لله

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